Doulas dish

When my husband and I discovered—surprise, surprise—that we were expecting our first child, one of the things we debated along with names, nursery colors, and which relatives to call first was hiring a doula to support us during labor. I knew without a doubt I wanted one, but my husband was less sure. What exactly was a doula, and what would she do for us?

Doula is Greek for "woman's servant." Today, the term usually signifies a trained professional who offers continuous physical, emotional, and mental support during labor and sometimes postpartum assistance including help with breast-feeding and infant care. Many doulas are childbirth educators, and some bring additional skills such as massage. Unlike a nurse or a midwife, a doula performs no medical tasks, and so is 100 percent free to focus on a woman's (and her partner's) needs.

During the past ten years, doulas have become increasingly popular, with membership in one of the primary doula organizations, DONA International (www.dona.org), increasing from just 750 in 1994 to more than 5,500 in 2006. And it's no wonder doulas are in high demand: In addition to increased overall satisfaction with the birthing experience (Obstetrics and Gynecology, 1999, vol. 93, no. 3), studies have shown that having a doula in the birth room can shorten labor by an average of 98 minutes, reduce the likelihood of cesarean section by 50 percent, and lessen the need for medicinal pain relief by 36 percent (American Journal of Obstetrics and Gynecology, 1999, vol. 180, no. 5).

But no statistic can convey the impact we felt our doula made during the labor and delivery of our daughter. Her gentle encouragement, expertise, and ability to reconcile the medical aspects of birthing with our intensely personal feelings and needs were invaluable. Here, three doulas shed some light on how they fit into the profound process of pregnancy, labor, and birth.

Katherine Bramhall Montpelier, Vermont-based childbirth educator, massage therapist, and doula who has attended births for more than 15 years

Q: What is your role during labor?

A: I spend a lot of time letting women know that giving birth may be painful, but it's the most transformative, powerful experience. That experience is what makes them a mom; it's what empowers them to make the hard choices that they're going to face as a parent.

What a doula doesn't do is equally as important: The role is never to make a decision for a birthing woman, because the decisions a woman makes in birth (and prenatally) are her first parenting decisions. So a doula just presents information. The doc comes into the room and says, "This is happening," and you just give the pros and cons of the decisions that the mother and her partner need to make.

Q: How is having a doula different from having a husband as labor coach?

A: When a woman says, "But my husband will be there," I tell her, "That means you'll both be in labor." Our culture expects husbands to take a detached role of birth coach when, in fact, in order to become a father, he has to go through a process himself during birth. So to expect him to be able to detach and say, "Well, darling, I think we should do this …" He's usually thinking, "Oh my God!" He's as in it as the mom.

A doula becomes the person who can witness the situation and help parents respond to whatever arises in a balanced way.

Q: How should a woman prepare for labor?

A: Make a list of the top five things she's afraid of in the process of birth. Find somebody she really trusts to help her with those fears. What are some of the things she can do in those situations? Fear is one of the biggest hang-ups during labor and delivery. I've seen women not give birth for endless numbers of hours because of fear. Working through those things with someone like a doula is very empowering.

Q: Describe a memorable experience.

A: Before I became a doula, I was a massage therapist, and I was working on a friend who was pregnant with her first child. She went into labor one afternoon and couldn't find her husband, so she called me. I just figured I'd go hang out with her until her husband showed up. When we got to the labor room she was already in transition [just before the baby begins to move down the birth canal]. Her husband showed up 20 minutes before the birth and I said, "I'll just let you guys be by yourselves now." She grabbed my hand and said, "You're not going anywhere. Don't leave me!" I realized that doing everything I knew how to do to care for another woman was natural for me. She gave birth to a little boy who is now my godson.

Janaki Costello La Leche League leader for 30 years, lactation consultant for 11 years and doula for 12 years, working in Berkeley, California

Q: Can you describe the role of a doula?

A: The doula's job is to provide continuous, calm, loving support. To offer practical suggestions for helping labor progress, for pain management and relaxation techniques. To provide education. To be a shoulder to lean on, and arms to enfold. To help parents develop their own self-confidence to birth and enjoy that baby.

Q: Why have doulas become so popular?

A: Women are not getting their emotional needs met by their doctors or hospitals, because Western medicine isn't set up for the whole person. It's set up for the pregnancy part—the biology. But being pregnant is more than measuring the fundus and listening to the heart rate. The doula honors and supports the emotional part as well.

Q: Do you have a favorite technique for helping women manage fear or pain?

A: I like to have women get physically comfortable, take deep breaths, and relax, and then to have them imagine entering a soothing space, such as their own living room or a beach or a beautiful meadow. I ask them to fully imagine everything about the place—its colors, textures, smell, the light, and any sounds. Whenever they are feeling anxious, they can return in their minds to that safe place.

Q: What is one of your most memorable experiences as a doula?

A: A woman who was having her second baby hired me. Her first labor had been six hours long, start to finish, with no medication. Her husband was delighted and thought natural birth was the way to go. But the mother felt completely traumatized by her first labor because it had been so intense and she had felt completely out of control. Even though her body knew how to birth her babies, a woman is more than just her body. She was someone who emotionally really needed to have an epidural, and her husband really didn't want her to have one. And so I had to speak up for her. She had the epidural and had her baby very shortly after, and felt great about the birth.

Devon O'Dell Atlanta-based, DONA-certified doula and childbirth educator in practice for 4 years

Q: What do you do as a doula?

A: I have a lot of knowledge about labor and birth. To have someone confidently say "This is normal" makes a huge difference in the parents' emotional well-being. For example, the vast majority of women hit transition and feel like, "I want medication! I can't do this! I'm sick of this!"

A lot of times, dads will say, "Whatever you want, honey." Whereas I can look at them and say, "Baby, you are soooo close! You are doing so well."

I also help parents get the information they need. I act as a facilitator of good communication between parents and staff, to help parents decipher the lingo. I can say, "Listen, this is what it means when you're 3 centimeters dilated and 90 percent effaced and your baby is at a minus-1 station." I also ask pertinent questions [of the medical staff]. A lot of times parents don't know what kinds of questions to ask.

Q: What is your most memorable experience?

A: A mom called me from the hospital and said, "I'm 7 centimeters [dilated], so let's go." But she sounded awfully chipper to be at 7 centimeters [10 centimeters is full dilation]. Sometimes, as in this case, babies are not in good positions—there's not adequate pressure on the cervix—so you end up with a funky labor pattern. I provided massage, aromatherapy, music, soft lights, but eight hours later, she was still at 7 centimeters. Finally, I suggested the tub. She got in, and she was just so beautiful. Her husband was pouring water over her belly, and I just tried to be as unobtrusive as possible.

I think that's what they really needed—to have that beautiful, intimate moment together. It was my job to set it up, and their job to make it happen. After she got out of the tub, she was completely dilated and started pushing, and the dad got to catch the baby with the midwife's assistance.

Q: Do you have a favorite technique for helping women manage pain?

A: I encourage women to use relaxed, normal breathing and vocalizations, which can be very powerful. Low moans, chanting, open sounds. Women shouldn't feel ashamed of making noise or sounding really powerful. I tell my doula clients that coping with labor does not mean that they are pretty, or quiet, or lying in the bed still. Rocking, moaning, cussing, praying, dancing—whatever it takes to get through that labor, that's what it takes.